Basic Information
| Provider Information | |||||||||
| NPI: | 1003085648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH COMMUNITY COUNSELING CENTERS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1855 E DUBLIN GRANVILLE RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432293516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142677003 | ||||||||
| FaxNumber: | 6142677013 | ||||||||
| Practice Location | |||||||||
| Address1: | 1855 E DUBLIN GRANVILLE RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432293516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142677003 | ||||||||
| FaxNumber: | 6142677013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GOUCH | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6142677003 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | OH | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 2341648 | 05 | OH | MEDICAID |